Heart failure is a syndrome of profound clinical and public health importance. Heart failure (HF) isestimated to contribute to nearly 1 million hospitalizations and approximately 250,000 deaths annually in the U.S. The number of new cases of HF in the U.S. is estimated to exceed400,000 annually. While reliable estimates of the magnitude, incidence, and mortality of HF remain lacking, HF is associated with a grim prognosis. Extremely limited data exists, particularly from the more generalizable perspective of a community-wide nvestigation, to determine whether the incidence or survival associated with HF, and the managementof this clinical syndrome, has changed over time. This study proposes to extend our original HFsurveillance project in the greater Worcester (MA) population to 3 new study years of 2002, 2004, and 2006. The objectives of this study will be to examine changing trends in our 3 new study years (2002, 2004, and 2006), in comparisonto our original 2 study years of 1995 and 2000, in the following major domains: incidence rates of HF, its therapeutic management, and changes over time in the hospital and long-term survival of patients with HFfrom a multi-hospital population-based perspective. The study will take place in residents of the Worcester (MA) metropolitan area (2000 census = 478,000) and will examine changes over time inthese and additional endpoints for patients with a validated acute episode of decompensated HFduring our 3new study years in comparison to our original 2 study years. Complementing the hospital surveillance of HF, newly diagnosedcasesof HF occurring in members of the largest HMO in Central Massachusetts during 2002, 2004, and 2006 will be identified and monitored over time. The proposed project will build on the investigators' clinical and epidemiological experienceand on data collection efforts and methodologies presently being used in the ongoing study of HF in greater Worcester residents. To accomplish our study objectives, the medical records of residents of the Worcester metropolitan area hospitalized with a discharge diagnosis of HF and related diagnostic rubrics will be individually reviewed and validated according to pre- established diagnostic criteria. Records for additional hospitalizations and death certificates will bereviewed to examine trends in long-term survival for the 5 hospital, and 5 outpatient, cohorts through 2008. The results of this study will provide much needed information about the epidemiology of HF from a more generalizable population-based perspective as well as insights into changing, and contemporary, managementstrategies and utilization of health care resources. Information would be provided about the clinical epidemiology of this prevalent and disabling condition in men and women and individuals of different age groups. The continued extension of this surveillance project will provide insights and guidance to public health and clinical efforts of HF and in monitoring trends in this newly emerging chronic disease.